PROJECT SUMMARY Diabetes disproportionately affects older adults. Recent estimates from the American Diabetes Association (ADA) found over 25% of U.S. adults over the age of 65 are living with diabetes, with the prevalence in African Americans almost double that in Caucasians. As the general population continues to age, the societal health burden associated with dysglycemia, and the associated racial disparities, will only continue to increase. Little is understood about the impacts of aging on the progression and associated complications of dysglycemia and prior findings in middle-age adults may not generalize to the aging population. With the dearth of focused work on this age group, most guidelines on the diabetes care of older adults remain based on expert opinion. Better characterization of the racial disparities and interaction of aging with dysglycemia in this population is needed to inform responsible evidence-based clinical care. Our proposed aims focus on addressing the following knowledge gaps using the longitudinal data available from non-Hispanic black and white adults in the Atherosclerosis Risk in Communities (ARIC) Study. 1. What are the racial disparities in the short-term clinical and subclinical outcomes of pre-diabetes and diabetes in older adults? 2. How does diabetes awareness, care practice, and treatment satisfaction differ by race in older adults? 3. What is the association of treatment understanding and satisfaction with burden of chronic diabetes-related complications? Do differences in these measures mediate the racial disparities in outcomes? We hypothesize that aging is a potential modifier of the physiologic impacts of hyperglycemia as well as the racial disparities in associated outcomes, contributing to differential risk profiles in this age group. With the complexities of aging, older adults present unique clinical challenges that require individualization of treatment. However, lack of standardized approaches may further exacerbate racial disparities. Disparities in disease awareness, care patterns, and treatment satisfaction could have implications for the severity of both clinical and subclinical complications. Our proposed work will supply insight into these open questions and provide the fellowship applicant with a rigorous mentored training in epidemiologic and biostatistical skills needed for her future career goals of becoming an academic physician-scientist.